Retrospective analysis of cases of acute endophthalmitis after surgery

To find out the prevalence and visual outcome of acute endophthalmitis after cataract surgery. Retrospective. 1[st] January 2001 to 31st December 2009. Wah Medical College, P.O.F. Hospital Wah Cantt, Rawalpindi. Fifty cases of acute endophthalmitis who had undergone treatment. Each case of acute endophthalmitis was evaluated in terms of presentation, detailed examination, treatment and outcome. Microbiological culture of the vitreous aspirates was also done to identify the causative organism. The analysis was also meant to identify the prognostic factors of visual outcome of these cases. Fifty patients presented with acute endophthalmitis out of the fifteen thousand cataract surgeries performed during the 9 year period. The incidence of endophthalmitis was 0.33% [95% CI]. A vitreous biopsy with intravitreal injection of antibiotics was done in all the cases presenting with acute endophthalmitis. Decreased visual acuity [90%] and pain [75%] were the main presenting features in these cases. There were 36 [72%] culture positive cases, with staphylococci [50%] being the most common organism found. Vitreous biopsy yielded positive results in 36 [72%] patients while negative results with no microbial growth was found in 14[28%] patients. There were 20 [40%] growths of coagulase negative staphylococci, 5 [10%] growths of streptococci, 8 [16%] growths of coagulase positive staphylococci, and 3 [6%] of gram negative organisms. The final visual outcome was recorded after one month. 8 [16%] patients achieved 6/12 or better, 26 [52%] patients achieved moderately good visual acuity 6/60 to 6/12, while 16 [32%] patients achieved poor visual acuity of less than 6/60. Of the latter group who had poor visual acuity, 2 [4%] patients had only perception of light while 1 [2%] patient had no perception of light and 1 [2%] patient had blind and painful eye who had to undergo evisceration. 6 [16%] patients achieved 6/12 or better visual acuity. The incidence of endophthalmitis is consistent with other studies. Laboratory diagnosis of the vitreous aspirates helps in the treatment. Achieving a good visual outcome is possible with treatment of the cases of acute endophthalmitis

Conjunctival squamous cell carcinoma;

To evaluate 20 patients with squamous cell carcinoma of the conjunctiva. To determine the clinical and pathological characteristics. Retrospective study. POP hospital and EDO eye hospital Wah.Cantt From June 200 to July 2006. The patients presenting with squamous cell carcinoma of the conjunctiva were retrospectively evaluated. Patients were usually male [80%], elderly [75% >60 years of age], with most lesions [90%] occurring at the limbus. Two patients [10%] suffered recurrence of the squamous cell of the conjunctiva within 2 to 4 months of resection. Corneal invasion was noted in two patients [10%] while there was intraocular and orbital invasion in two patients [10%]. One patient [5%] required enucleation and one patient [5%] required exenteration. In situ carcinoma was noted in 18 patients [90%]. Squamous cell carcinoma of the conjunctiva occurs in the sun exposed area of the conjuntiva at the limbus in the elderly men. Recurrence was noted in the younger patients and with larger lesions. Enucleation and exenteration is required in a small number of cases

Visual acuity; assessment of efficacy and safety of different doses of intravitreal triamcinolone

To compare efficacy of different doses of intravitreal triamcinolone on the best corrected visual acuity and assess the safety of the drug. The study was carried out at Al-Shifa Trust Eye hospital Rawalpindi, and Rawalpindi General Hospital Rawalpindi. 99 eyes of 99 patients with clinically significant macular edema were randomized to treatment with 2mg, 4mg, 6mg and 8mg of intravitreal triamcinolone.19 patients were lost in the follow up. Follow up of the patients was scheduled for twenty four weeks to assess the changes in the best corrected visual acuity and the side effects of the drug such as rise in intra ocular pressure between the four groups. There was a significant improvement of best corrected visual acuity in all the four groups. The mean BCVA improvement in the 8mg was higher than the 2mg group with an improvement of 2 lines and 1 line respectively. [P=0.04]. the rise in the intra ocular pressure [>21 mg] occurred in 5%, 5%, 5% 40% in the 2mg, 4mg, 6mg and the 8mg respectively. The higher doses of intravitreal triamcinolone may increase and prolong the visual benefits in cases of clinically significant macular oedema but the rise in intra ocular pressure remains an area of concern. More studies are required to assess the optimum dose of intravitreal triamcinolone

Decreasing efficacy of repeated intravitreal triamcinolone injection in diabetic macular oedema

To assess the efficacy of 4mg of repeated intravitreal injection of triamcinolone for the treatment of diabetic macular oedema. This is a case series of twenty eyes of twenty patients who received repeated injections of 4 mg of intravitreal triamcinolone at least 24 weeks after the first injection The best corrected visual acuity was compared after the first and repeated injection of intravitreal triamcinolone and at 2, 4, 8 and 12 weeks after the first and repeated injection of intravitreal triamcinolone using the paired t test. Side effects were also monitored. The best corrected visual acuity was significantly less in the repeated intravitreal injection at all follow ups [p <0.05] as compared to the initial injection of triamcinolone .The rise in the intraocular pressure and the cataract score were not significantly different in the initial and repeated injections of intravitreal triamcinolone. The repeated injection of 4 mg of intravitreal triamcinolone is not as effective as the initial injection of the same dose

Evaluation of photo refractive keratectomy with corneal topography

To analyze the incidence and clinical characteristics of different topographic patterns after photorefractive keratectomy and the effect of different topographic patterns on best corrected visual acuity. This prospective study was carried out at Al Shifa Trust Eye Hospital a series of 100 eyes of 50 patients who had undergone PRK, were evaluated postoperatively with video Keratograph [HS Keratograph 922]. The different topographical patterns were studied and there relationship to visual acuity was considered. The patients were evaluated at 4 weeks and 12 weeks follow up. The patients were mostly in the age group of 20 to 30 years. Fifty patients were selected for the study. The incidences of the various ablation patterns on corneal topography were studied. The corneal topography at one. month showed that fifty- one eyes [60.71%] had a homogenous pattern and the contours of the cornea were uniform. Twenty -one eyes [25%] were found to have the central islands while six eyes [7. 14%] had the semicircular pattern. The remaining six [7.14%] eyes had the keyhole pattern of ablation. The incidence of the various ablation patterns on corneal topography at three months showed that seventy- five eyes [89.28%] had a homogenous pattern. Five eyes [5.95%] were found to have a central island while two [2.38%] eyes had the semicircular pattern. The remaining two eyes [2.38%] had the keyhole pattern of ablation. The postoperative topographies revealed that the most common ablation zone pattern was homogenous pattern [60.71%] followed by central island pattern [25%]. The loss of best spectacle corrected visual acuity at one month was more in the eyes with postoperative central island pattern [23.81%] as compared to the homogenous pattern [5.45%]

Refractive error study in strabismic children: results from Al-Shifa Trust, Rawalpindi, Pakistan

To assess the prevalence of refractive error and visual impairment in children with strabismus. Study design:-Hospital based prospective study. July 1995 to June 1998. A total of 1120 strabismic children between the ages of 02-l 5 years were examined to identify those having refractive error. visual acuity measurement, cycloplegic retinoscopy, ocular motility evaluation and examination of the external eye, anterior segment, media and fundus were performed in all the strabismic children. Out of 1120 strabismic children, 622 [55.54%] had esotropia, 370 [3104%] had exotropia and 128 [11.42%] had vertical strabismus.148 [13.21%] were emmetropic, 972 [86.79%] strabismic children had refractive errors. Esotropia was the most common strabismus followed by exotropia and vertical strabismus. Severe visual impairment was found in 27.30% of the strabismic children. The most common refractive error was hypermetropia followed by astigmatism and myopia. About half of all the strabismic children had amblyopia